Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.

The Effect of Predictive Nursing Intervention on Cardiac Function and Clinical Outcomes in CCU Patients with Acute Myocardial Infarction After Interventional Therapy

Objective:To evaluate the impact of predictive nursing on the care of acute myocardial infarction(AMI)patients in the Coronary Care Unit(CCU)after interventional therapy.Methods:From September 2021 to September 2023,84 AMI patients admitted to the CCU were randomly divided into two groups:the experimental group(42 patients)received predictive nursing,and the reference group(42 patients)received conventional nursing.Cardiac function and clinical outcomes were compared between the groups.Results:Before nursing,there was no difference in cardiac function between the two groups(P>0.05).After nursing,the cardiac function of the experimental group was better than that of the reference group(P<0.05).The clinical outcomes of the experimental group were better than those of the reference group(P<0.05).Before nursing,there was no difference in psychological scores between the two groups(P>0.05).After nursing,the psychological scores of the experimental group were lower than those of the reference group(P<0.05).Conclusion:Predictive nursing can improve the cardiac function and clinical outcomes of AMI patients after interventional therapy and can also regulate patients’negative psychological states.

Randomized controlled trials on Roy adaptation model nursing in patients with acute myocardial infarction in china: a systematic review

Objective:This study was to evaluate the quality of the randomized controlled trials on Roy adaptation model nursing in individuals suffering from acute myocardial infarction in China.Methods:We systematically searched the Cnki,Wanfang and Vipdatabases,to get randomized controlled trials on Roy adaptation model nursing in individuals suffering from acute myocardial infarction.The search period was from inception to October 2020.According to the Cochrane risk bias assessment tool,the quality of the studies included was appraised.Results:A total of 55 studies were retrieved,and 11 were eventually included in the study.Among the studies included,the first study was published in 2008.The overall quality of the 11 studies included was relatively low.Conclusions:The overall quality of the randomized controlled trials on Roy adaptation model nursing in individuals suffering from acute myocardial infarction was not high,which would hinder the evidence transformation as well as clinical practice.

Effect of Continuous Nursing Intervention on Psychological State and Medication Compliance of Patients with Acute Myocardial Infarction after PCI

Objective:To explore the effect of continuous nursing intervention on psychological status and medication compliance of patients with acute myocardial infarction after PCI operation.Methods:from February 2013 to September 2016,102 patients with acute myocardial infarction treated by PCI were selected and divided into two groups,51 cases in each group according to the different nursing methods.The observation group was added continuous nursing on the basis of routine nursing,while the control group was the usual nursing mode.The mental state of the two groups before and after treatment was evaluated,and the patients were followed up for 6 months after discharge.The compliance of the two groups at 1,3 and June after discharge was statistically analyzed.Results:before nursing,there was no significant difference in the mental state evaluation between the two groups(P>0.05).After nursing,the mental status of the two groups was improved,while the psychological state of the observation group was better than that of the control group(P<0.05).After 6 months'follow-up,there was no significant difference in the compliance rate between the two groups at 1 months after discharge(P>0.05).In 3 and June,the compliance of the patients in the observation group was better than that in the control group(P<0.05).Conclusion:continuous nursing intervention for patients with acute myocardial infarction after PCI can effectively adjust the unhealthy psychological state of patients,improve medication compliance and promote early rehabilitation of patients.

Application Analysis of Cardiac Rehabilitation Nursing in Patients with Acute Myocardial Infarction

Objective: Application analysis of cardiac rehabilitation in patients with acute myocardial infarction. Methods: A total of 102 patients with acute myocardial infarction admitted to our hospital from January 2020 to January 2022 were retrospectively selected as the observation objects. According to the nursing measures taken, they were divided into a control group and an observation group, with 51 cases in each group. A total of 51 patients in the control group received routine nursing, while 51 patients in the observation group were guided to actively participate in the cardiac rehabilitation nursing plan. The hospitalization conditions and effects of the two groups were compared. Results: The cardiac function index, bed time, hospitalization time, anxiety score and depression score of the observation group were significantly better than those of the control group, and the differences were statistically significant (P Conclusion: The application of cardiac rehabilitation nursing in patients with acute myocardial infarction has a good effect. The patients’ cardiac function recovers faster, they feel more comfortable, and they also reduce the time of hospitalization and bed rest, which is conducive to improving the psychological and anxiety state of patients and improving the quality of life.

Application of Evidence-based Nursing in Elderly Patients with Arrhythmia after Acute Myocardial Infarction

Objective: To investigate the effect of evidence-based nursing intervention in elderly patients with arrhythmia after acute myocardial infarction. Methods: 146 elderly patients with arrhythmia after acute myocardial infarction treated in our hospital from February 2016 to March 2017 were selected as research objects. According to the random number method, patients were divided into control group (73 cases, traditional nursing) and observation group (73 cases, evidence-based nursing intervention). The clinical effects and nursing satisfaction of the two groups were compared. Results: The hospital stay, average bed rest time, hospitalization cost, and incidence of arrhythmia complications in the observation group were significantly lower than those in the control group. The difference was statistically significant (P<0.05). After nursing, the four grades of heart function and satisfaction of nursing in the observation group were significantly higher than those in the control group. The difference was statistically significant (P<0.05). Conclusions: In elderly patients with arrhythmia after acute myocardial infarction, evidence-based nursing intervention was adopted. The patient's health has been greatly improved and the doctor-patient relationship has been significantly improved. This method is worth promoting.

Continuously Happened Three Mechanical Complications after Acute Myocardial Infarction: Report of a Rare Case

Revascularization to infarcted area after left ventricular free-wall rupture has been controversial. A 68-year-old man with acute myocardial infarction presented to our hospital and developed a left ventricular free-wall rupture. We repaired the left ventricular oozing rupture without culprit artery revascularization, however, followed by papillary muscle rupture and left ventricular blow-out rupture, which resulted in sudden death.

Impact of smoking cessation counseling among acute myocardial infarction patients on post-hospitalization mortality rates:a systematic review

Objective:The current systematic review aimed to assess the impact of smoking cessation counseling(SCC)on patients’short-and long-term mor tality after acute myocardial infarction(AMI).Methods:The Cochrane guidelines were used to conduct a systematic review of Medline(Pub Med),Science Direct,CINAHL Cochrane database,and Google Scholar for studies on the impact of SCC on AMI patients’mor tality.Results:Five studies were found to meet the predefined inclusion criteria.Smoker patients were not routinely counseled to quit smoking during their post-AMI hospital stay.Studies showed a reduction in mor tality among AMI patients’who received SCC compared with patients who did not receive it.Conclusions:SCC during hospitalization and after discharge is a simple and cost-effective intervention that improves AMI patients’survival.

A risk score model for predicting cardiac rupture after acute myocardial infarction

Background:Cardiac rupture (CR) is a major lethal complication of acute myocardial infarction (AMI).However,no valid risk score model was found to predict CR after AMI in previous researches.This study aimed to establish a simple model to assess risk of CR after AMI,which could be easily used in a clinical environment.Methods:This was a retrospective case-control study that included 53 consecutive patients with CR after AMI during a period from January 1,2010 to December 31,2017.The controls included 524 patients who were selected randomly from 7932 AMI patients without CR at a 1:10 ratio.Risk factors for CR were identified using univariate analysis and multivariate logistic regression.Risk score model was developed based on multiple regression coefficients.Performance of risk model was evaluated using receiveroperating characteristic (ROC) curves and internal validity was explored using bootstrap analysis.Results:Among all 7985 AMI patients,53 (0.67%) had CR (free wall rupture,n=39;ventricular septal rupture,n=14).Hospital mortalities were 92.5% and 4.01% in patients with and without CR (P<0.001).Independent variables associated with CR included:older age,female gender,higher heart rate at admission,body mass index (BMI)<25 kg/m^2,lower left ventricular ejection fraction (LVEF) and no primary percutaneous coronary intervention (pPCI) treatment.In ROC analysis,our CR risk assess model demonstrated a very good discriminate power (area under the curve [AUC]= 0.895,95% confidence interval:0.845–0.944,optimism-corrected AUC= 0.821,P<0.001).Conclusion:This study developed a novel risk score model to help predict CR after AMI,which had high accuracy and was very simple to use.

Rupture of the Anterolateral Papillary Muscle Caused by a High Lateral Branch Occlusion

Although necrosis of the left ventricular papillary muscles during acute myocardial infarction is common, rupture of the anterolateral papillary muscle due to occlusion of high lateral branch is rare. We present a rare case of anterolateral papillary muscle rupture caused by occlusion of a high lateral branch of the left coronary artery. Although the patient was in cardiogenic shock on admission, she was successfully treated by emergency mitral valve replacement after percutaneous catheter intervention and intra-aortic balloon pumping support. This case implies that the anterolateral papillary muscle can have a single blood supply and that it can be ruptured by an occlusion of a high lateral branch. Prompt diagnosis, immediate mechanical stabilization and aggressive surgical treatment are essential to save this group of patients.

Application effect of optimized emergency nursing process in the rescue of patients with acute myocardial infarction

Background Acute myocardial infarction is a common and prevalent cardiovascular disease that can lead to serious consequences such as shock,arrhythmia,and heart failure.In dealing with acute myocardial infarction,the optimization of emergency nursing process can ensure the effectiveness and safety of rescue work,and help improve the prognosis and rehabilitation of patients.Methods 68 cases of patients with acute myocardial infarction admitted to our hospital from August 2021 to March 2023 were selected as the subjects of this study.They were randomly divided into an observation group and a control group,with 34 cases in each group.The control group received routine nursing care,while the observation group received optimized emergency nursing process based on it.the success rates of rescue,emergency efficiency,complications,and hemodynamics were compared between the two groups.ResultsThe success rate of rescue in the observation group was 100.00%,while in the control group it was 88.24%,the success rate of rescue was statistically different between the two groups(P<0.05).The observation group had shorter time intervals from onset to hospital admission,shorter door-to-activation time,shorter door-toballoon time,and reduced length of hospital stay compared to the control group(P<0.05).The total proportion of patients with complications such as arrhythmias in the observation group was 0.00%,while in the control group it was 11.76%,the difference between the two groups was statistically significant(P<0.05).The Cardi-ac output(CO)index of the observation group and the control group is lower than before the nursing intervention,and the observation group is higher than the control group.The Mean arterial pressure(MAP)index of the observation group and the control group is lower than before the nursing intervention,and the observation group is lower than the control group(P<0.05).Conclusions Optimized the emergency nursing process can improve the success rate of rescue and emergency efficiency in patients with acute myocardial infarction,reduce the occurrence of adverse complications,and improve negative emotions such as anxiety.It is worth promoting and applying.

早期心脏康复护理对急诊PCI术后患者心功能及生活质量的影响

目的探讨早期心脏康复护理在急诊经皮冠状动脉介入治疗术(PCI)术后患者中的应用效果。方法选取2020年4月至2021年2月在商丘市第一人民医院接受经桡动脉行急诊PCI治疗的急性心肌梗死(AMI)患者139例为研究对象,并将其分为对照组(70例)、干预组(69例)。给予对照组常规护理,干预组在此基础上接受早期心脏康复护理干预。比较两组患者心功能及生活质量评分。结果接受早期心脏康复护理干预的急诊PCI术后患者心功能评估(左心室射血分数、左心室舒张末期内径、心输出量、每搏心输出量)结果与对照组比较,差异无统计学意义(P>0.05)。接受早期心脏康复护理干预的急诊PCI术后患者,出院1个月后生活质量4个维度(一般健康状况、生理职能、社会功能、生理机能)评分均高于对照组(P<0.05)。结论早期心脏康复护理干预能提高急诊PCI术后患者生活质量,建议临床推广应用。

经穴推拿联合中药穴位贴敷对急性心肌梗死病人便秘及心血管事件的预防作用

目的:分析急性心肌梗死(AMI)病人采用经穴推拿联合中药穴位贴敷对便秘及心血管事件的预防作用。方法:选取2022年1月—12月于我院心血管内科收治的100例AMI病人作为研究对象,按照随机数字表法分为对照组和观察组,各50例。对照组实施常规护理干预;观察组在对照组基础上给予经穴推拿和中药穴位贴敷。比较两组便秘及心血管事件发生率、心功能指标、生活质量等。结果:干预期间,观察组病人便秘发生率(8.00%)低于对照组(40.00%),差异有统计学意义(P<0.05);观察组心血管事件发生率(6.00%)低于对照组(26.00%),差异有统计学意义(P<0.05);干预后,观察组肌钙蛋白、脑钠肽水平低于对照组,左室射血分数高于对照组,差异有统计学意义(P<0.05);随访后时,观察组生活质量量表(SF-36)各维度评分均高于对照组,差异均有统计学意义(P<0.05)。结论:经穴推拿联合中药穴位贴敷可有效预防AMI病人便秘,降低心血管事件风险,有利于促进心功能恢复,提高生活质量。

急性ST段抬高型心肌梗死合并心脏破裂的列线图模型建立

[目的]分析急性ST段抬高型心肌梗死(STEMI)患者发生心脏破裂(CR)的风险因素,并依此构建急性STEMI患者合并CR的列线图模型。[方法]通过宁夏医科大学总医院大数据研究平台、医院信息系统检索连续纳入2015年1月—2019年12月急性STEMI患者5412例,其中合并CR的91例患者为CR组,5321例未合并CR患者为非CR组。运用LASSO回归、单因素及多因素Logistic回归分析急性STEMI患者合并CR的风险因素,并建立CR的列线图预测模型。分别运用受试者工作特征曲线、Hosmer-Lemeshow检验、临床决策曲线分析法(DCA)对建立的列线图模型进行验证和评估。[结果]LASSO回归结果显示年龄、女性、高血压病史、首次医疗接触时间、休克指数、Killip分级、白细胞计数、D二聚体、乳酸、前壁心肌梗死、24 h内服用β受体阻滞剂、24 h内服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)药物、急诊PCI共13个变量为CR的风险因素(P<0.05)。把筛选出的13个风险因素分别进行单因素及多因素Logistic回归分析,结果提示年龄、Killip分级、首次医疗接触时间、白细胞计数、未行急诊PCI、24 h内未服用ACEI/ARB药物是急性STEMI患者合并CR的风险因素。依据上述6个风险变量建立急性STEMI合并CR列线图模型。该列线图模型内部验证前后ROC曲线下面积分别为0.946(95%CI:0.927~0.961)、0.947(95%CI:0.927~0.959),灵敏度分别为0.957、0.904,特异度分别为0.858、0.876,说明该模型具有较好的区分度。运用Hosmer-Lemeshow检验证明该模型的预测价值和实际观测值之间的偏差没有统计学意义(χ^(2)=12.70,P=0.122),说明列线图模型具有较好的校准度。DCA曲线提示模型的预测概率阈值在0.00~0.40之间,临床净获益最高,说明具有较好的临床效能。[结论]本研究建立的列线图模型有较好的区分度、校准度和临床效能,能有效预测急性STEMI合并CR的发生概率,为临床诊疗工作提供一定帮助,以期降低CR发生率。

双心护理结合早期康复策略在急性心肌梗死患者中的应用价值

目的研究双心护理结合早期康复策略在行经皮冠脉介入术(PCI)后的急性心肌梗死患者中的应用价值。方法以随机数字表法将2021年3月至2022年7月在东南大学附属中大医院行PCI的90例急性心肌梗死患者分为2组,各45例。对照组接受早期康复结合常规护理,观察组在对照组干预方法的基础上接受双心护理。比较2组的心功能指标、不良情绪、生活质量和心血管不良事件发生情况。结果术后1个月和3个月,2组的N末端脑钠肽前体水平均较术前降低,且观察组均比同期对照组更低;2组的左室射血分数均较术前增大,且观察组均比同期对照组更大;2组的6分钟步行试验距离均较术前增长,且观察组均比同期对照组更长,上述比较均有统计学差异(P均<0.05)。术后1个月和3个月,观察组的不良情绪评分(汉密尔顿焦虑/抑郁量表)均低于同期对照组(P均<0.05),且2组均低于术前(P均<0.05)。术后3个月,2组的生存质量精简量表各项评分均较术前高(P均<0.05),且观察组均高于对照组(P均<0.05)。观察组的心血管不良事件总发生率低于对照组(P<0.05)。结论双心护理结合早期康复策略可改善行PCI后的急性心肌梗死患者的心功能、不良情绪和生活质量,也可预防心血管不良事件的发生。

甘油三酯葡萄糖指数与心肌梗死后室间隔穿孔患者30天预后的相关性研究患者的临床特征及预后比

目的探讨甘油三酯葡萄糖指数(TyG)与心肌梗死后室间隔穿孔患者30天全因死亡率的关系。方法回顾性分析2009年1月至2023年10月中国医学科学院阜外医院和新疆维吾尔自治区人民医院冠心病重症监护病区收治的急性心肌梗死合并室间隔穿孔患者(n=132)的临床资料及30天预后情况,根据TyG均值分为低TyG组(TyG≤9.25,n=71)和高TyG组(TyG>9.25,n=61)。采用多因素Cox回归分析及Kaplan-Meier分析来验证TyG指数的应用价值。结果与低TyG组(TyG≤9.25)相比,高TyG组患者组年龄更大[(67.6±8.4)岁比(64.0±10.2)岁,P=0.028],男性比例更高(50.8%比31.0%,P=0.020),白细胞水平上升幅度更大[(13.54±5.55)×10^(9)/L比(11.03±4.45)×10^(9)/L,P=0.005],30天全因死亡率更高(57.4%比36.6%,P=0.017)。多因素回归分析提示,低TyG指数(HR=0.502,95%CI 0.302~0.835,P=0.008)是30天全因死亡的保护性预测因素。结论TyG指数是急性心肌梗死合并室间隔穿孔30天全因死亡的潜在预测指标。

对经皮冠状动脉介入治疗术患者行以奥马哈系统为指导的同质化护理管理实践

目的探讨以奥马哈系统为指导的同质化护理在行经皮冠状动脉介入治疗术(PCI)后的急性心肌梗死(AMI)患者中的应用效果。方法选取2021年5月至10月在南京市第一医院心内科行PCI的52例AMI患者为对照组,2021年11月至2022年4月收治的52例为干预组,对照组患者予以常规护理,干预组患者在对照组基础上辅以奥马哈系统为指导的同质化护理。比较两时间段围手术期护理质量、患者满意度、两组患者住院时间及住院费用。结果干预组围手术期护理质量评价得分、患者满意度得分显著高于对照组,差异具有统计学意义(P<0.05);干预组患者平均住院时间及住院费用均明显少于对照组,差异具有统计学意义(P<0.05)。结论基于奥马哈系统为指导的AMI行PCI术后患者同质化护理管理可提高患者满意度及围手术期护理质量,缩短住院时间及住院费用。

胸痛中心优化护理管理在急性心肌梗死患者中的应用效果

目的:观察胸痛中心优化护理管理在急性心肌梗死(ACI)患者中的应用效果。方法:回顾性分析2020年1月至2022年12月该院急诊科收治的80例ACI患者的临床资料,按照护理管理方法不同将其分为对照组和观察组各40例。对照组实施常规胸痛中心护理管理,观察组在对照组基础上实施胸痛中心优化护理管理。比较两组护理管理质量评分、急救相关指标(心电图完成时间、发病至首次医疗接触时间、心肌损伤标志物检测完成时间、导管室激活时间)水平、主要心血管不良事件发生率和急救满意度。结果:观察组护理管理质量评分高于对照组,差异有统计学意义(P<0.05);观察组心电图完成时间、发病至首次医疗接触时间、心肌损伤标志物检测完成时间、导管室激活时间均短于对照组,差异有统计学意义(P<0.05);观察组主要心血管不良事件发生率为2.50%(1/40),低于对照组的20.00%(8/40),差异有统计学意义(P<0.05);观察组急救满意度为100.00%(40/40),高于对照组的80.00%(32/40),差异有统计学意义(P<0.05)。结论:胸痛中心优化护理管理应用于ACI患者可提高护理管理质量评分和急救满意度,改善急救相关指标水平,降低主要心血管不良事件发生率,效果优于常规胸痛中心护理管理。

基于时间节点为导向的院内快速急救模式在急性心肌梗死中的应用

目的 分析基于时间节点为导向的院内快速急救模式在急性心肌梗死(AMI)应用方面的效果。方法 挑选2020年1月—2021年6月新疆医科大学第一附属医院治疗的AMI患者597例设为对照组,实施常规急救护理干预,选取2021年7月—2022年12月急诊收治的597例AMI患者设为观察组,实施基于时间节点为导向的院内快速急救模式干预。比较两组救治流程时间、心肌酶谱水平、抢救效果及护理满意度情况。结果 观察组分诊时间、完成院内首份心电图时间、急诊球囊开通时间、急诊室停留时间、经皮冠状动脉介入(PCI)术治疗时间均比对照组短(P<0.05)。出院前1 d观察组心肌酶谱指标心肌肌钙蛋白(cTnT)和肌酸激酶同工酶(CKMB)水平均比对照组低(P<0.05)。观察组住院时间比对照组短(P<0.05),并发症出现的概率及病死率方面,观察组(分别为3.69%、1.68%)均比对照组(11.22%、7.71%)低(P<0.05)。观察组护理总满意度(95.64%)比对照组(79.06%)高(P<0.05)。结论 基于时间节点为导向的院内快速急救模式在了AMI患者救治过程中能有效缩短各个救治流程时间,减少心肌损伤,提升救治效果及护理满意度,改善患者预后。

急性心肌梗死PCI术后病人便秘预防与管理的最佳证据总结

目的:检索并总结国内外急性心肌梗死(AMI)病人经皮冠状动脉介入治疗(PCI)术后便秘预防与管理的相关证据,为临床实践提供依据。方法:根据“6S”模型系统检索国内外数据库及相关专业网站,检索时限为2018年1月1日—2023年5月31日,文献类型包括临床决策、推荐实践、指南、专家共识、系统评价、证据总结等,对文献进行质量评价,提取证据并进行总结。结果:共纳入16篇文献,包括4篇指南、3篇专家共识、1篇推荐实践、1篇临床决策、7篇随机对照试验研究。提取包括专业护理团队、评估时机和内容、基础管理、药物护理及中医护理技术5个方面,共38条最佳证据。结论:本研究汇总了急性心肌梗死PCI术后病人便秘预防和管理的最佳证据,医护人员可结合具体临床情境有针对性地选择、应用证据,减少便秘和心脏不良事件的发生。